CLINICAL TRIAL / NCT02611531
Video vs. TTG Respiratory Inhaler Technique Assessment and InstructioN (V-TRaIN)
- Interventional
- Recruiting
- NCT02611531
Contact Information
Video vs. TTG Respiratory Inhaler Technique Assessment and InstructioN (V-TRaIN)
The purpose of this study is to evaluate the effectiveness of two different ways to teach subjects while hospitalized how to use respiratory inhalers and to follow-up after discharge home from the hospital to determine durability of the education.
Asthma and Chronic obstructive pulmonary disease (COPD) results in over a million
hospitalizations in the United States annually and COPD is the third leading cause of
30-day re-hospitalizations. Clinical trials have established the efficacy of treatments
primarily dispensed via respiratory inhaler devices that reduce morbidity and health care
utilization if they are used correctly. Unfortunately, the effectiveness of these
medications in real-world settings is limited by the fact that patients often do not use
inhalers correctly. Current guidelines recommend assessing and teaching inhaler technique
at all health care encounters, including hospitalization. My work has found that over 75%
of hospitalized patients in an urban, predominantly underserved population misuse their
respiratory inhalers, highlighting a missed opportunity to educate these patients with
high potential to benefit. Hospitalization, therefore, provides a potential 'teachable
moment' to correct this misuse. My preliminary data indicate that one strategy, in-person
teach-to-goal (TTG), is effective in teaching hospitalized patients proper inhaler
technique and is more effective than simple verbal instruction.
While TTG is a promising method to improve care for patients who use inhalers, several
limitations prevent widespread adoption. First, TTG relies on in-person assessment and
education, as well as training and monitoring instructors to ensure fidelity, making it
time-consuming and costly. Also, because a single educational session does not ensure
long-term retention, post-discharge reinforcement may be needed, which may be impractical
with in-person TTG. One potential method to surmount TTG's limitations is use of
interactive video module education (VME), a method that has been used for health
education in other clinical contexts. Through iterative self-assessments and
video-demonstrations on a tablet computer, VME has the potential to be less costly,
maintain fidelity, and be more easily extended into the post-discharge setting than
in-person TTG. However, certain questions remain about VME. It is unclear whether VME
will yield similar results when compared to TTG, or whether patients will have the
ability to, and be willing to use, VME in the post-discharge setting. Therefore, before
widespread implementation of VME, it is critical to rigorously develop and test VME for
inhaler education in the hospital setting. Ultimately, it will also be important to
understand patients' ability and willingness to use post-discharge VME for educational
reinforcement to allow for this strategy to transition patients across care settings from
hospital to home.
Gender
All
Age Group
18 Years and up
Accepting Healthy Volunteers
No
Inclusion Criteria:
1. Age 18 years and older
2. Admission to the inpatient medical service and surgical service
3. Physician-diagnosed COPD or asthma. We will enroll patients even if the primary
reason for admission is not COPD or asthma (e.g., patients admitted for heart
failure, but with a physician diagnosis of COPD are eligible).
Exclusion Criteria:
1. Currently in an intensive care unit
2. Physician declines to provide consent
3. Patient unable to provide consent (e.g., history of cognitive impairment, unable to
understand English) or declines to provide consent